urgent care: a practical guide to transforming same-day care in
TRANSCRIPT
Department of Health
20 March 2009
Dear Dr Carson, Mr Clay and Mr Stern
Urgent Care - a practical guide to transforming same-day care in general practice
The Royal College of General Practitioners (RCGP) and the British Medical Association’s General Practitioners Committee (GPC) support the Primary Care Foundation’s report Urgent Care – a practical guide to transforming same-day care in general practice. This report throws a spotlight onto an often neglected but very important aspect of general practice. Urgent care can be managed by practices in a wide variety of ways and we welcome this report’s acknowledgement that solutions must be locally formulated within the available resources.
The RCGP and GPC support your conclusion that practices should review their access arrangements and their balance of appointment types and staffing. The examples and practical advice contained within your report will help practices to do this. We would certainly encourage all practices to assess their urgent care arrangements and to set themselves achievable goals for improvement where appropriate.
Practice capacity will be critical in determining practices’ ability to improve patients’ experience of urgent care. All too often practices’ desire to improve patient services is frustrated by insufficient capacity, substandard premises and inadequate funding. The ability of practices to implement many of your recommendations depends heavily on Primary Care Organisation (PCO) support and predictable, adequate practice funding. We support your recommendation that PCOs should support practices with resources, expertise and advice.
Yours sincerely
Steve Field Laurence BuckmanChairman of Council Chairman Royal College of General Practitioners General Practitioners Committee
Primary Care Foundation161 High StreetLewesEast SussexBN7 1XU
General Practitioners Committee
The system must be safe for patient
Fundamental principles
Secondary principles Which implies
©Primary Care Foundation
Minimal delay reacting toa patient that presents
Must deal with patients wherever they present
Must avoid long queues (for initial phone call, assessment or face-to-face)
Receptionists have adequate training / process to identify potentially urgent cases
Potentially urgent cases should be assessed by a clinician as early as practical
Must have adequate receptionists for calls and face-to-face
Must have ‘duty clinician’ or other arrangements for early assessment
Must have capacity and plans to react if patient needs to be seen
Build ‘safety netting’ (advising callers what to do if the condition worsens / does not improve) into the process
In cases of doubt ensure that the patient isassessed or seen sooner rather than latterIn cases of doubt ensure that the patient isassessed or seen sooner rather than latter
In cases of doubt ensure that the patient is assessed or seen sooner rather than later
Urgent is defined by patient until assessed
Plans and capacity to respond as needed
In cases of doubt, thenerr on the side of safety
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Score on the Erlang Formula
Num
ber
of p
ract
ices
enough staff or phone lines not enough staff or phone lines
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1500
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500
2000
2500
Less than rule of thumb
More than rule of thumb
©Primary Care Foundation
Total number of face-to-face appointments per 10000 patients for surveyed practices
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1.2
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1.4
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1.6
1.8
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2.5
2.7
2.9
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3.5
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7.9 8
Score on the Erlang Formula
Num
ber
of p
ract
ices
Patient Calls
not enough staff or phone lines
Would you like an appointmentin 2 or 3 days or is it
something more urgent?
The Doctor/Nurse is availablefor advice, can I get them to
call you back within 20 minutes?Book Telephone Slot
Make Appointment
Make Same Day Appointment
Episode Complete
Episode Complete
2 or 3 days
Yesphone
No, need appointment
Episode Complete
It is more urgent
Basicgeneralpractice
Focus onpatientsafety
Multipleaccesspoints
Respond to changing
demand
Warm andwelcoming
culture
Patient safety
No delay inphone response
Reception staffalert to potential
emergencies
Check withpatient to validateplanned response
Decisions arerecorded at all
stages withgovernance
process
Urgent conditionsidentified
Early reviewof same-day case
Responds todemand
An Informationsystem that
enables staffto review changing
patterns of demand
Sufficienttelephone lines andstaff to respond at
peak times
A system thatavoids relying on
add-ins at endof surgeries
Build in morecapacity on
Mondays and other peak times
Reserved capacity for same-day
demand
Multipleaccesspoints
Walk-inservice as well
as phoneaccess
Accessvia website
Range oftreatment
options
Use of aduty doctor
or nurse
Rapidlyassessing all
home visitrequests
Bookabletelephone
appointments
Rapidtelephone
assessment
Choice of seeing doctor
or nurse
Walk-in Service as
well as phoneaccess
Culture of practice
Considerthe physical
layout of reception area
System designed
to meet the needsof many rather
than focusing onthe difficult
few
Receptionstaff are
encouragedto interrupt
doctor if unsure
Style ofdealing with
patients
Reserved capacity for same-day
demand
